The International AIDS Conference Returns: So Much Still To Do

A quick Sunday note: At 5 p.m. today, Eastern time, something extraordinary will happen in Washington, D.C. It won’t look like much — just the opening of a big conference in a big convention center — but when the 19th International AIDS Conference begins its opening ceremonies, it will mark the first time in 22 years that the largest international gathering on the epidemic, the centerpiece of research and activism, has been held on US soil.

Twenty-two years is effectively one generation — there are probably people attending the conference who were not born when it was last held in this country — as well as two-thirds of the time this disease has been with us. So I think it’s worth underlining how momentous this is, and how it potentially signals a new moment in the long fight against HIV.

A recap, for anyone who isn’t familiar with the story: The first cases of what would come to be recognized as AIDS were spotted in California in 1981. The virus was simultaneously discovered by US and French teams in 1983. The first AIDS conference, a small gathering of researchers, was held in Atlanta in 1985. In 1987, the US Senate unanimously passed an amendment forbidding anyone with known HIV infection from entering the United States even temporarily, preventing many activists and patient representatives from attending. At the time, the conference was an annual event (bi-annual, now), and was held alternately in the US and in some other country. The rule went into effect in time to severely disrupt the 1990 conference, in San Francisco, and the next US location, Harvard University, said it would refuse to host unless than ban was lifted. It was not, and the conference and its showcasing of AIDS research, treatment and prevention went abroad and stayed there. It is back now because, in late 2009, President Barack Obama lifted the travel ban.

So much happened in those 22 years. When the conference left, AIDS was still an invariable and ugly death sentence; the multi-drug cocktails, known as HAART for “highly active antiretroviral therapy,” were not introduced until 1996. I think it must be close to impossible for anyone who was not around at the time to understand what it was like, in the days before HAART. When I remember it — I lost many friends in the early days — I get a glimmer of what 1918 must have been like, or possibly even the Black Death: Dozens of people you know, almost all at once, desperately ill, and shunned, and then gone. A good place to start, to understand it, is the new documentary How to Survive A Plague, and also this post by Andrew Sullivan, describing the days just before HAART arrived. (The great historical document, of course, is “And The Band Played On,” a masterwork of investigative journalism by Randy Shilts, still in print 25 years after its publication and 18 years after Shilts’ own death from AIDS.)

The latest report from UNAIDS, the United Nations agency that monitors the global epidemic, backs up the sense that things are changing. The report, released Wednesday, found that among the 34.2 million people living with HIV, fewer are dying: There were 1.7 million deaths last year worldwide, compared to 1.8 million the year before and a peak of 2.3 million in 2005. At the same time, the report said, new infections are declining too, by almost 20 percent in the past 10 years.

Simultaneously, after many years of disappointments, research is returning hopeful results for both prevention and treatment. Three years ago, scientists reported the first promising findings in the search for an HIV vaccine, considered the key to global eradication. Two years ago, researchers published the first partially successful trials of both a microbicide and a drug cocktail that may prevent infection. Last year, a nine-country trial demonstrated that getting infected people into treatment very quickly can keep them from passing the disease along. And since 2007, scientists have been closely watching the “progress of the “Berlin patient” — the only person, out of 60 million believed to have been infected in more than 30 years, who appears to have been cured of HIV.

There will be so much news coverage out of the conference this coming week that I don’t know which news source to recommend that you read. But I do recommend that you read, and not let the conference news slide by in the stream. This is, still, so important. There is so much left to do.

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